PERCEPTION OF OSCE AS AN ASSESSMENT TOOL IN UNDERGRADUATE STUDENTS OF PRIVATE MEDICAL COLLEGE IN KARACHI, PAKISTAN Saba Pario, Shaista Bashir Anwar, Zafar Haleem Baloch, Saira Ghafoor, Shazia Aftab, Sadia Rashid, Sadia Suboohi, Zahra Salauddin Pakistan Journal of Medical & Health Sciences Vol. 15, NO.8, AUG 2021 Objective: To explore the perception of undergraduate students of United Medical and dental college towards objective structured clinical examination as an assessment tool. Material & Methods: A cross-sectional observational study included undergraduate medical students, Results: 153 students who completely filled the proforma were included in study among them 31% were male and 69% were females. Mostly agreed that stations in OSCE were simple and easily interpretable and assessed practical skills thoroughly. Majority of students accepted that skills inquired were taught in clinics, stations were according to course and stations were appropriately timed. 66 % confirmed that adequate instructions were provided before exam. 84.31% believed that OSCE is preferable to viva. 57.51% of candidates stated that examiners during OSCE were attentive and gracious but 20.91 % objected it , while 21.57% remained neutral. Almost half of examinees labelled it as comprehensive clinical assessment. Overall, 67.97 % perceived OSCE as demanding and tough assessment. Finally views of students for statement that OSCE is unbiased, reliable and valid were positive in 50.32%.There was a significant difference in the opinion of male and female( p-value is less than 0.05) in statement that OSCE thoroughly assessed practical skills, stations were according to course of instruction, Adequate instructions were provided before exam, superior and preferable to viva, assists in improvement of clinical skills, demanding and tough and finally OSCE was unbiased, reliable and valid Conclusion: OSCE was perceived as fair, comprehensive, un-biased format of examination but believed it was more stressful than traditional examination methods. Keywords: Assessment, Attitude, OSCE, Perception, Undergraduate Medical students. 80
FREQUENCY OF ABNORMAL PLACENTAL HISTOPATHOLOGY AND THEIR ASSOCIATION WITH ADVERSE PERINATAL OUTCOMES Saira Ghafoor, Nazish Ali, Zafar Haleem Baloch, Syeda Fariha Hussain, Aliya Waheed, Fehmida Pakistan Journal of Medical & Health Sciences vol 14, NO. 4, OCT – DEC 2020 Objective: To determine the frequency and pattern of abnormal placental histopathology and its impact on adverse fetal outcomes. Study Design: Cross-sectional/Observational Place and Duration: This study was conducted at department of Obstetrics and Gynaecology, Jinnah Medical and Dental College Hospital Korangi, Karachi for duration of six months from 1st June 2019 to 30th November 2019. Methodology: One hundred and fifty five women with normal or C-section deliveries were enrolled. After taking informed written consent, detailed demographics including age, gestational age, body mass index, mode of delivery and co-morbidities were recorded. Placenta of each patient was examined macroscopically and sent to laboratory for histopathological examination. Frequency of abnormal placenta was recorded. Association between abnormal placenta and poor neonatal outcomes were examined. Data was analyzed by SPSS 27.0. Results: Mean age of patients was 28.75±5.34 years. Mean gestational age was 38.24±2.16 weeks. Abnormal placenta was found in 45 (29.03%) patients while 70.97% had normal placenta on histopathology. Out of 45 abnormal placenta, vessel wall thickness was found in 31 (68.89%), infarction found in 8 (17.77%), chorioangiosis found in 4 (8.89%), and villitis in 2 (6.67 %). A significant association was observed between abnormal placenta and adverse fetal outcomes with p-value <0.05. Conclusion: Abnormal placental histopathology was found in 29.03% and significantly associated with adverse fetal outcomes. Keywords: Placental Histopathology, Neonatal Outcomes, Neonatal death, Low-birth weight, NICU Admission, Apgar Score. 81
MATERNAL AND PERINATAL OUTCOME IN ADOLESCENT AND ADULT PRIMIGRAVIDA Shazia Aftab, Huma Baloch, Komal, Saadia Rashid, Saira Ghafoor, Aliya Waheed International Journal on Women Empowerment DOI: 10.29052/2413-4252.v7.i1.2021.X-X Volume 7 Issue 1 29/06/2021 Background: Improving maternal and child health is prioritized globally; however, adolescent pregnancies remain the prime one among the many obstacles. The study aimed to determine the maternal and perinatal outcomes in adolescent and adult primigravida. Methodology: This cross-sectional study was carried out between 1st December 2018 to 30th November 2019, over a sample of 487 pregnant women (primigravida), presenting at the Jinnah Medical College Hospital, Karachi, for childbirth/delivery. The patients were categorized as adolescents (aged ≤19 years) and labelled as group A and adults (aged 20-34 years) labelled as group B, comprising 83 and 404 patients. Data were recorded using a structured questionnaire containing details pertaining to socio-demographic characteristics, labour, delivery and immediate postpartum period complications of pregnancy. The data was analyzed using SPSS version 23.0. Results: A total of 1738 deliveries were completed in the study duration at Jinnah Medical College Hospital, Karachi. The mean age of the women was 18.35 ± 0.06 years, and the modal age was 27 years. The mean gestational age of the women was 36.86 ±2.15 weeks among teens and 38.55 ± 0.55 weeks among adults. The incidence of adverse outcomes was higher among maternal [anemia; 46.9% (p-value 0.05)] and perinatal [preterm delivery (20%), low birth weight (22%), stillbirth (11.5%) and perinatal mortality (10%); p<0.05] was higher among teens. Conclusion: It is concluded that teenage pregnancies are comparatively riskier than adult pregnancies for the child and the mother, as is apparent from the significant difference in maternal and perinatal adverse outcomes observed in the study. Keywords: Teenage Pregnancy, Adult Primigravida, Maternal Outcome, Perinatal Outcome, Maternal & Child Health. 82
CAN SIMULATION-BASED EDUCATION REPLACE THE HANDS-ON EXPERIENCE LEARNING DURING THE COVID-19 PANDEMIC? Fadieleh A. Sohail, Marium Iqbal, Samia Perwaiz Khan, Safia Izhar International Journal of Endorsing Health Science Research Vol 9 No 3 (2021): Background: Although simulation-based learning is expensive but cost-effective and advantageous as well if utilized appropriately. It is known to enhance clinical competence among medical students. There is a dire need to enhance the utilization of simulation-based clinical teaching skills to replace hands-on experience involving patients. The objective of this article was to highlight the importance of simulation-based education (SBE) in medical training. Methodology: For the study purpose, literature focusing on the use of SBE in medical training was reviewed. The databases including Google Scholar, PubMed, Research gate, Scopus, The Nation news, BBC news were searched using the keywords Simulation-Based Education, Clinical Skills, Vygotsky’s Zone of Proximal Development, Objectively Structured Clinical Examination and COVID19. We also designed a pilot study to demonstrate the effect of simulator- based training among medical students. Results: Efforts are being made to support SBE as an alternative method for clinical skill training in medical and dental undergraduate students during this pandemic. As it is cost-effective, ensures patient safety, and reduces the risk of health hazards by refining the medical provider's abilities. Conclusion: Due to the pandemic, skill training sessions on simulators via zoom can play a significant role in improving skills among medical students with the least exposure to COVID-19 infection. Keywords: Simulation-Based Education, COVID-19, Clinical Skills, Vygotsky’s Zone of Proximal Development, Objectively Structured Clinical Examination. 83
IDENTIFICATION OF CONSUMER’S PREFERENCE TOWARDS STORE IMAGE: USING ANALYTICAL HIERARCHICAL PROCESS TECHNIQUE Dr. Musarrat Shamshir, Dr. Shahzad Nasim, Zaibunnisa Siddiqi, Muhammad Raza, Muhammad Sameer Ahmed Journal Of Southwest Jiaotong Vol 56, No 2 (2021) This study aims to identify consumer preferences for store image using the Analytic Hierarchy Process. Analytic Hierarchy Process is a Multiple Attribute Decision-Making technique used to observe, rank, and select a set of options under contradictory characteristics. Consumer preference refers to the individual's behavior when purchasing, consuming, or disposing of any specific product or service. Multiple factors can affect these behaviors. The store's attractive features are the factor affecting store image, dimension, and subdimension of store image. Data were collected from 29 experts. Experts are selected based on their experience of shopping in a shopping mall in Pakistan and industry. A bipolar questionnaire was used to collect data. This study explored the main dimensions of store image: convenience, price, quality, atmosphere, and safety. Further, the study's findings indicate that these dimensions of store image are important for marketers, which provides awareness regarding the psychological elements of customers that influence their perception of store image and helps the marketer recognize and forecast the customer's demand. Keywords: Consumer’s Preference, Consumer’s Behavior, Store Image, Analytic Hierarchy Process, Shopping Mall 84
THE RELATIONSHIP BETWEEN HUMAN RESOURCE MANAGEMENT AND CORPORATE SOCIAL RESPONSIBILITY: A CRITICAL REVIEW Zaibunnisa Siddiqi, Dr. Manzoor Ali Mirani, Dr. Shahzad Nasim, Dr. Musarrat Shamshir, Sidra Nisar Journal of Southwest Jiaotong University / Vol.56 No.2 Apr. 2021 An increasing number of organizations are focusing not only on creating value but also on ethical, social, and environmental perspectives. Traditionally, organizations mostly encompassed corporate social responsibility as their activities only in an economically favorable situation. However, corporate social responsibility can be incorporated in organizations with human resource management as a strategic process to recover and sustain the organization's development. Therefore, the study aims to analyze the relation between corporate social responsibility and human resource management and the role of human resource practices with corporate social responsibility in organizational development. From this standpoint, this study provides a systematic review of the concepts of corporate social responsibility, the relation between corporate social responsibility and human resource management, and their effect on the organization's success. Fifty-six articles published during 2004–2020 are selected for review from a descriptive and content perspective to propose a future research direction on a selected topic. The findings of the reviewed literature indicated that a triple bottom line (economic, social, and environmental) attainment is essentially a high-level management driven operation in the absence of employee participation. Besides, this paper described the importance of corporate social responsibility, the linkage between human resource and corporate social responsibility in the organization, and promoting corporate social responsibility to the organizations and various stakeholders. Finally, this study asserted the connection between these two concepts and inquired management to treat the link as a strategic business decision to control the organization's human capital. Keywords: Corporate Social Responsibility, Human Resource Management, Organizational Success 85
TALENT MANAGEMENT, AN APPROACH FOR IMPROVING HR PRACTICES Zaibunnisa Siddiqi, Shahzad Nasim, M. Anwer Baz Khan, Musarrat Shamshir Palarch’s Journal Of Archaeology Of Egypt/Egyptology 18(4), 6534-6545. ISSN 1567-214x Talent management is still in an emerging phase in the Pakistani banking industry specifically in the public sector and is becoming a key strategic HRM issue for the banking industry. This study adds to our knowledge by conducting interviews with HR executives of the banking industry. Due to a lack of employee knowledge, skills, and experience baking industry is facing challenges to retain employee loyalty even in the technological era. The study aims to identify the issues associated with new, dynamic, and talented employees in the baking industry and the ways to mitigate these challenges. The proper management of new employees will ultimately lead towards competitive advantage hence, the overall effectiveness of the entire business. The qualitative research methodology, inductive research approach, and interpretive research paradigm is used for the data collection and analysis. criterion sampling techniques are used to select the participant in the study, and semi-structured and open-ended questionnaire is used to conduct the interviews. Content and narrative analysis have been done to find out the result. The findings indicated that Talent management is a concept, which helps the organization for managing its hidden potentials, extracts the best out of it. In addition, talent management is aligned with the HR practices including recruitment and selection, training and development, and performance management system. Keywords: Banking Industry, Talent Management, Employee Performance, Employee Retention 86
DETERMINANTS OF CAPITAL STRUCTURE: A STUDY OF FERTILIZER INDUSTRY OF PAKISTAN Jahangir Tanveer, Musarrat Shamshir, Shahzad Nasim, Sidra Nisar, Salman Ahmed Shaikh Palarch’s Journal Of Archaeology Of Egypt/Egyptology 18(6), 152-161. ISSN 1567-214x The capital structure of a firm determines the ability to raise the capital of the firm by impacting market price and earnings per share for the shareholder. Capital structure is a mixture of debt and equity such that to choose from different options available to the organization for financing its assets. Higher leverage implies an increase in total earnings of the firm due to the excess of earnings on borrowing than the interest payment on debts. Both in financial and non-financial sectors, researchers find it interesting to determine the attributes that impact capital structure The current study aims at investigating the relationship of profitability, size, growth, and tangibility with leverage and their significance in determining the capital structure of the firm by using the data from 2010-2019, of the fertilizer industry in Pakistan by considering all six firms in the industry, listed in Pakistan stock exchange; namely, Engro Fertilizers; Fatima Fertilizers, Fauji Fertilizer Corporation, Fauji Fertilizer bin Qasim Ltd and Pak Arab Fertilizer. Hausman specification test is applied to check the appropriation of model among fixed and random effect. The findings revealed the significance of all the variables. Profitability, size, and tangibility were found negatively correlated while growth was found to be positively correlated with leverage. Keywords: Capital Structure; Leverage; Equity; Debt; Housman Test 87
A COMPARATIVE STUDY OF MANAGEMENT OF FEMORAL SHAFT FRACTURE IN CHILDREN Hassan Amir Us Saqlain, Niaz Hussain Keerio, Ghazanfar Ali Shah, Syed Abdur Rub Abidi, Zahoor Illahi Soomro, Imtiaz Ahmed Tago Annals of R.S.C.B., Vol. 25, Issue 7, 2021 Context: Fracture of the shaft of the femur is one of the major pediatrics trauma resulting in a lifelong disability. There are many treatment options available including early application of Spica cast, external surgical fixation, intramedullary nailing or conservative treatment that involves immobilization for a prolonged period of time, mostly in a hospital setup. Aim: The aim of this study is to examine the consequences and functional outcomes of the fractures of femoral shaft in pediatric department which were treated with intramedullary internal fixation (using K-wire and Titanium elastic nail) as the potential of malunion is greater in elastic nails specially if weight is heavier and it allows full weight bearing without cast . Study Design and Method: A prospective study conducted at the Department of Orthopedic, Specialist Orthopedic, Al Qassimi Hospital Sharjah EHS United Arab Emirates from February 2019 to January 2020. Total of 80 children were evaluated for this study with age between 4-11 years having unstable in close reduction of femoral shaft. Each participant was followed up for 12 months to check unions, malunions, delayed unions, or nonunions and excellent, good, and poor outcomes Results: On statistical analysis of the outcome of the treatment and prognosis of the results based on Flynn et al criteria 72.5% had excellent outcome scores in Group A treated with titanium nails) and 70% in Group B (treated with stainless steal K wires. On general statistical analysis, both the groups showed similar rates in post-operative complications. Conclusion: The two groups showed similar results in terms of union, partial full weight bearing activities after the intramedullary nailing intervention was evaluated. However, stainless steel Kirschner wire has certain advantages over titanium elastic nail making it a slightly better option which include: cost effectiveness, easy availability, lesser pre-operative hospital stay and lesser surgical waiting time. Keywords: Children, Adolescents, Femoral shaft fractures, femoral fixation, intramedullary nails, titanium elastic nails, Kirschner wire. 88
ROLE OF ALENDRONATE AND PARATHYROID HORMONE IN POSTMENOPAUSAL OSTEOPOROSIS: A RANDOMIZED CLINICAL TRIAL Zahoor Illahi Soomro, Imtiaz Ahmed Tago, Syed Abdur Rub Abidi, Ghazanfar Ali Shah, Niaz Hussain Keerio, Hassan Amir Us Saqlain Annals of R.S.C.B Vol. 25, Issue 7, 2021 Aim: To compare the role of Alendronate and Parathyroid Hormone in Postmenopausal Osteoporosis Study Design: Randomized Clinical Trial Place and duration: This study was conducted in Peoples University of Medical & Health Sciences Nawabshah, Pakistan from Jan 2019 to Jan 220 Methodology: Total 238 women with deficient bone mineral density in the hip or spine were examined by dual-energy X-ray absorption spectroscopy (DxA) and Quantitative CT (QCT) over the course of a year for bone mineral density. They were randomly allocated to alendronate,parathyroid hormone and both alendronate and parathyroid hormone (Combination therapy) groups. Individuals who were fasting were subjected to a blood test to search for indicators of bone turnover. Result: There was no statistically important alteration in the improvement of spinal bone mineral density between the parathyroid hormone and combination-therapy groups. There was an improve in trabecular bone volumetric density at the spine in all three groups, although it was approximately twice as great in the parathyroid hormone group. Only in the group taking parathyroid hormone did bone development rise significantly. Both the combined therapy and alendronate groups had a reduction in bone resorption. Conclusion: There was no sign that parathyroid hormone and alendronate functioned together in a synergistic manner. When alendronate is used with parathyroid hormone, it's likely that changes in volumetric bone density, hip cortical volume, and indicators of bone turnover will occur, counteracting the parathyroid hormone's anabolic benefits. An extensive amount of fracture research must be conducted over an extensive period of time in order to discover anyanti-resorptive medications may be utilized in combination with parathyroid hormone treatment Keywords: osteoporosis, parathyroid hormone, alendronate, postmenopausal 89
ORGANIZATIONAL STRESS AND JOB PERFORMANCE: A CASE STUDY OF POLICE OFFICERS IN DISTRICT QUETTA Muhammad Asif Buledi, Prof. Dr. Musarrat Adnan, Hafsa Karim, Tayyaba Zia, Rabeea Zia, Rafia Kanwal, Abdul Rauf Bangulzai Webology Volume 18, No. 5, 2021 Police work and professional stress never been in larger attention. Though the work of police is concern with the stress they may have facing different type of difficulty and various issues related to the stressful environment which they facing every day in their professional life. The empirical study aim for this was to examine the level of workload, work environment, nature of work and relationship with supervisor with work stress among police officers, in district Quetta Baluchistan. All the police constables were the population of the study. The research method approach for this study was mixed method. The descriptive analysis was done on 30 officers of police department, using simple random sampling technique by quantitative method through questionnaire. In qualitative method seven respondents were taken as sample by using convenient sampling and thematic analysis was done. Therefore, the findings of quantitative method show that the workload is a highest stressful factor, while life threatening, social isolation, sudden work calls, promotion, salary issue were the major themes of the study. Present study recommends that the smart salary packages and value should be given to them. Keywords: Stress, Workload, Nature of work, Work environment 90
ALLERGIC BRONCHOPULMONARY ASPERGILLOSIS MISDIAGNOSED AS SMEAR NEGATIVE PULMONARY TUBERCULOSIS; A RETROSPECTIVE STUDY FROM PAKISTAN Nousheen Iqbal, Muhammad Dawood Amir sheikh, Kausar Jabeen, Safia Awan, Muhammad Irfan Annals of Medicine and Surgery Volume 72, December 2021, 103045 Background: Undiagnosed allergic bronchopulmonary aspergillosis (ABPA) can lead to chronic persistent symptoms. In country like Pakistan where tuberculosis (TB) is endemic, a significant proportion of ABPA patients are misdiagnosed as smear negative TB before reaching a diagnosis of ABPA due to chronicity of symptoms. This lead to empiric use of ATT(Anti-tuberculous therapy) and delay in primary diagnosis. The aim of the study is to determine such proportion of ABPA patients. Material and methods: This retrospective study was conducted at the outpatient pulmonology clinic of a tertiary care hospital in Karachi, Pakistan from January 2017 to December 2018. Xpert MTB/Rif, TB smear and culture were performed in all patients to rule out active TB. Results: A total 167 of ABPA patients were included. Mean age of the patients was 41.9 ± 13.0 years, 91(54.5%) were female and 71 (42.5%) patients had received ATT in past. Out of these 71 patients, 63 (88.7%) patients were diagnosed as smear negative TB and received empiric ATT. Among 63 patients, 52 (82.5%) patient had received ATT once, 8 (12.6%) twice and 3 (4.7%) patients had received empiric ATT thrice. Of these 27 (16.16%) patients had already developed long term complications at the time of diagnosis of ABPA and 17 (62.96%) patients were in empiric TB treatment group. Conclusion: Patient with ABPA frequently received empiric ATT as smear negative TB in high TB burden country. This results in over diagnosis of TB and unnecessary use of global resource. When Gene Xpert negative alternate diagnosis should be considered. Keywords: Smear negative tuberculosis, Allergic bronchopulmonary aspergillosis, Asthma, Misdiagnosis 91
MOTIVATION AND JOB SATISFACTION AMONG MEDICAL AND DENTAL COLLEGE FACULTY IN PAKISTAN AMID THE COVID-19 OUTBREAK Saqib Ali, Beenish Fatima Alam, Sara Noreen, Madiha Anwar, Sabeen Hashmat Qazi, Talib Hussain Work, vol. 69, no. 2, pp. 359-366, 2021 The novel coronavirus (COVID-19) has affected economies all over the world. The ability of an organization to grow is heavily influenced by job satisfaction and employee motivation. This study examines the factors affecting employee motivation and job satisfaction among medical and dental college faculty members in Pakistan, both in the private and public sector, during the COVID-19 pandemic. Medical and dental college faculty in Pakistan comprised the sample for this multi-centric cross-sectional study. A questionnaire, which was modified from an existing study, was distributed electronically. A student’s independent t-test was applied to compare the mean scores of the responses from public and private sector employees. Of the 466 total respondents, 55% were female and 45% male. Public sector faculty reported receiving adequate resources and preferred online teaching. Both public and private sector faculty reported being satisfied with regular workshops and training. Private sector employees demonstrated more satisfaction with workplace safety measures. Public sector faculty highlighted the positive influence of job security and timely salary payments on productivity. Faculty members from both the public and private sector find working from home to be easier and better for handling one’s workload. Public sector faculty noted job security, timely salary payments, and an individual’s sense of achievement as sources of motivation. Private institutes are more lacking in ensuring their faculty feel content and satisfied. Measures should be undertaken to improve the level of motivation felt by faculty members, especially in the private sector. Keywords: Incentive, contentment, employees, pandemic, teaching 92
ASSESSING THE BELIEFS ABOUT ANTIDEPRESSANT MEDICATION AND ADHERENCE TO THERAPY IN PATIENTS WITH MAJOR DEPRESSIVE DISORDERS Prof. Dr. Samia Perwaiz Khan, Dr. Shagufta Naqvi, Dr. Rabeea Rizwan, Mariam Ansari, Shaista Emad, Habib ur Rahman Khan, Aafia Akhtar, Maniya Syed, Naija Ehsan, Anas Moorad Annals of Psychophysiology2021,Vol8(1),:pp 25-34. Background: Patients on antidepressant therapy have no contact with their physicians until their next appointment which in most cases could be more than two weeks apart. This crucial time is of utmost importance as this could assess the patients will to follow the prescribed therapy and the overall belief about the benefits of use of antidepressant therapy. Thus adherence to medication is necessary to reduce risk of suicidal tendencies and mortality in these patients. The study was conducted to evaluate the belief about medication and adherence to anti-depressant therapy in patients with major depressive disorder. Methodology: One hundred one clinically diagnosed patients with Major Depressive Disorder (MDD) were included in the study from psychiatric and medical OPD from 10th June-2018 to 10th June - 2019, from Jinnah Medical College Hospital (JMCH) who were currently, on the prescribed antidepressant therapy. Belief about medicines questionnaire (based on BMQ) BMQ specific and BMQ general, regarding their views about the prescribed medication. BY the modified questionnaire of medication adherence scale, scores were calculated to give a numerical value to measure the adherence to antidepressant medication. Results: According to the study 101 patients of major depressive disorder had overall good beliefs about medication but have low adherence. Belief about medicines questionnaire (based on BMQ) BMQ- specific q1-10 score was 36.54 (necessity, concern), BMQ -general 27.98 score, q11-18 (overuse and harm). Regarding their views about the prescribed medication. 86% of participants with major depressive disorder had low adherence (scores 0-5) and those with high adherence were only 14% (scores 6-8). The patients diagnosed with major depressive disorder who had co-morbids (diabetes, hypertension, hypothyroidism, etc.) had better adherence for their prescribed treatment as compared to those without co-morbids. Conclusion: This study indicates that although patients with major depressive disorder from tertiary care hospital in Karachi had positive belief about medication but have low adherence to antidepressant therapy. Keywords: Major depressive disorder (MDD), antidepressant drugs, beliefs about medicines, questionnaire (based on BMQ), Modified adherence questionnaire (based on Medication Adherence Scale). 93
AL-HIJAMA- A POSSIBLE CURE FOR DEPRESSION: A PILOT STUDY Sabeela Noor, Saida Haider, Fasiha Fatima, Mahparah Mumtaz Sch Int J Tradit Complement Med, 4(11), 179-183. 23.11.2021 Background: Al-Hijama is an ancestral treatment option used in different societies for the cure of various diseases. Depression is now become epidemic in in several countries. Objectives: In this pilot study we have investigated the probable effects of Al-Hijama on improving depression symptoms with the score of geriatric depression scale (GDS) in local population. Methods: 132 eligible participants were enrolled in this open label single arm pre and post clinical trial for 3 months. Depression was assessed by using geriatric depression scale (GDS) before and after Al-Hijama therapy. Results: The mean score of depression calculated by GDS in study group were 8.95 ± 2.09 before intervention and 6.05 ± 1.54 after one month and 4.63 ± 1.47 after 3 months of continue Al-Hijama sessions. The decrease in depression scale between pre and post intervention was statistically significant (p< 0.001). Conclusion: Our study showed statically significant improvement in depression after Al-Hijama therapy. In future more studies should be conducted on larger scale to assess the effectiveness of this treatment option. Keywords: Alternative Medicine; Al Hijama; Depression; Wet Cupping. 94
COVID-19: AN EMERGING CULPRIT OF INFLAMMATORY ARTHRITIS Muhammad Shariq Mukarram, Muhammad Ishaq Ghauri, Sehrish Sethar, Nasir Afsar, Amir Riaz, Khizra Ishaq Hindawi Case Reports in Rheumatology Volume 2021, Article ID 6610340, 8 pages https://doi.org/10.1155/2021/6610340 Arthralgia is one of the most common symptoms that occur in patients with COVID-19. About 15% of patients present with arthralgia at some point. Although COVID-19 seems to attack the musculoskeletal system (muscles and joints) in its infective and postinfective stage causing inflammatory arthritis, not much is known about the rheumatic manifestations of this infection. In this case series of 5 patients, we discuss the occurrence of bilaterally symmetrical polyarthritis in patients, previously free from any rheumatic disease, after encountering COVID-19 infection. The musculoskeletal manifestations in these patients phenotypically resembled rheumatoid arthritis. These patients were treated successfully with low-dose glucocorticoids and disease-modifying antirheumatic drugs (DMARDs). 95
OCULAR MANIFESTATIONS IN A PATIENT WITH DANDY-WALKER MALFORMATION: A CASE REPORT Qirat Qurban, Zeeshan Kamil, Sameer Saleem Tebha, Zain Ali Zaidi, Maahirah Said, Samar Fatima Zehra, Sajjad Ali, Sehrish Sethar journal homepage: www.elsevier.com/locate/radcr 2021 Dec 31;17(3):812-815 We present a unique case of a ten-month-old boy with a protruding left globe and vitreous haemorrhaging, and later being diagnosed as a case of a dandy-walker syndrome (DWS) with buphthalmos and vitreous haemorrhage. Treatment is depending on the symptoms reported, thus close monitoring and a multidisciplinary approach are essential. We would like to recommend that even if there are no cardinal symptoms of DWS, paediatric patients with ocular signs should have Dandy walker Malformation (DWM) considered as a differential diagnosis. Keywords: Buphthalmos; Dandy walker Malformation; Enlarged fourth ventricle; Ocular manifestation; Posterior fossa; Vermis hypoplasia; Vitreous hemorrhage. 96
INCIDENTAL FINDING OF RIGHT-SIDED IDIOPATHIC SPONTANEOUS ACQUIRED DIAPHRAGMATIC HERNIA Zain Ali Zaidi, Sameer S Tebha, Sehrish S Sethar, Sakshi Mishra Cureus 13(6): e15793. DOI 10.7759/cureus.15793 2021 Jun 21;13(6):e15793 Spontaneous acquired diaphragmatic hernia is a rare finding which occurs in the absence of any trauma or surgery. Here, we present the case of an 83-year-old male who presented to the outpatient department complaining of nausea, vomiting, epigastric pain and sensation of fullness, loss of appetite, and occasional episodes of constipation, with no history of trauma or surgery. Clinical examination revealed no specific cause. A clinical diagnosis of cholelithiasis was initially suspected and confirmed by an ultrasound of the abdomen. However, considering the worsening of symptoms, a computed tomography scan revealed an incidental right-sided spontaneous diaphragmatic hernia. A subsequent laparoscopic surgery for cholecystectomy and the correction of the right-sided defect in the diaphragm was performed. spontaneous acquired diaphragmatic hernia occurring secondary to a defect on the right side of the diaphragm without any history of trauma or surgery is an extraordinary and infrequent radiological finding. Considering the challenging clinical diagnosis of such hernias, clinicians should be vigilant when patients exhibit worsening symptoms of nausea, vomiting, and gastrointestinal obstruction with or without respiratory and cardiac complications. The surgical management of such hernias is effective and secure and usually requires either an abdominal or thoracic approach and a combination of both accesses in some cases. Keywords: hiatal hernia, laparoscopic cholecystectomy, computed tomography, bochdalek hernia, case report, morgagni hernia 97
RESPIRATORY PATHOGENS IN PATIENTS WITH ACUTE EXACERBATION OF NONCYSTIC FIBROSIS BRONCHIECTASIS FROM A DEVELOPING COUNTRY Shayan Shahid, Kauser Jabeen, Nousheen Iqbal, Joveria Farooqi, Muhammad Irfan Monaldi Arch Chest Dis 2021 Apr 22;91(2). doi: 10.4081/monaldi.2021.1771. About the spectrum and antimicrobial spectrum of pathogen yielded from respiratory specimens in adult patients with acute exacerbation of non-cystic fibrosis (CF) bronchiectasis. This cross-sectional study was performed at the pulmonology clinics of the Aga Khan University, Karachi, Pakistan from 2016-2019. Respiratory specimens were collected from adult patients with acute exacerbation of non-CF bronchiectasis presenting in pulmonology clinics. Microbial cultures were performed using standard methodology. Susceptibility testing was performed and interpreted using Clinical Laboratory Standard Institute criteria. A total of 345 positive cultures from 160 patients presenting with acute exacerbation were evaluated. The most frequent organisms were Pseudomonas aeruginosa (n=209) followed by Hemophilus influenzae (n=40) and Staphylococcus aureus (n=24). High rates of antimicrobial resistance were found in all these pathogens. Proportion of Pseudomonas aeruginosa strains resistant to ciprofloxacin, imipenem, ceftazidime and piperacillin-tazobactam were 27.1%, 16.8%, 14.8% and 13.1% respectively. 65% of Hemophilus influenzae strains were resistant to cotrimoxazole and ciprofloxacin and 66.7% of Staphylococcus aureus strains were resistant to methicillin. High antimicrobial resistance in non-CF bronchiectasis patients against commonly used antimicrobials is a concern and highlight need for urgent community level interventions to improve clinical outcome in these patients. Keywords: Bronchiectasis; etiology; infection; drug resistance. 98
DEPTH OF INVASION AS A PREDICTOR OF CERVICAL NODAL METASTASIS OF ORAL TONGUE SQUAMOUS CELL CARCINOMA: FINDINGS FROM A TERTIARY CARE CENTER IN PAKISTAN Adnan Y. Muhammad, Rahim Dhanani, Summaiya Salman, Zeeshan Shaikh, Shayan K. Ghaloo, Mubasher Ikram Cureus 2021 Oct 22;13(10):e18976. doi: 10.7759/cureus.18976. eCollection 2021 Oct. Background and Objective: Cervical lymph node metastasis has a significant impact on the survival of patients with oral cavity tumors. The rate of occult neck node metastasis is reported to range from 20 to 40%. The depth of invasion (DOI) has been incorporated in the eighth edition of the American Joint Commission on Cancer (AJCC) staging manual and is an important predictor of cervical lymph node metastasis. In this study, we aimed to identify the occult neck node metastasis rate in early oral tongue squamous cell carcinoma (OTSCC) and correlate it with the DOI. Methods: A retrospective review of all patients presenting to our facility with early-stage OTSCC was performed. Patients with tumor size of ≤4 cm and who underwent elective neck dissection at the time of surgery were included. The study outcomes were the rates of occult neck metastases in T1 and T2 OTSCC and their correlation with the DOI. Results: There were 80 patients in total. Occult neck node metastases were seen in 29 (36.25%) patients. Patients with a DOI >5 mm were 1.41 times more likely to have occult neck node metastasis than those with a DOI ≤5 mm. Conclusion: Occult neck node metastasis is significantly associated with the DOI. The risk of neck metastasis is higher in patients with a DOI >5 mm. 99
FEAR AND PERCEPTION OF PEOPLE TO VISIT DENTISTS DURING COVID19 PANDEMIC AND THEIR SUGGESTIONS Muhammad Mansoor Majeed, Zarah Sidiqqui, Muhammad Uzair, Azam Shahzad, Sara Rafique, Shoaib Durrani European Journal of General Dentistry 2021; 10(03): 129-134 Objectives: This study was performed to determine patients’ fear and perception of visiting dentists during the COVID-19 pandemic. Materials and Methods: This cross-sectional study was performed online using Google forms. Participants included individuals who had been to dental clinics for treatment. The data of 407 participants were analyzed. SPSS 21 was used for data entry and analysis. Demographic variables were expressed in numbers and percentages. The Chi-squared test was applied to analyze the difference between the demographic variables and fear among genders, age, and level of education. Results: Due to the coronavirus’s contagious nature, fear is prevalent among a significant number of patients (χ2 ¼ 31.373, p < 0.001). Females are more afraid to visit the dentist than males (χ2 ¼ 7.065, p ¼ 0.008). The majority of the patients are not willing to go for dental treatment other than an emergency. Around two-thirds of the participants reported that their visit to the dentist during the current pandemic was reduced. Conclusion: Due to the fear of COVID-19, patients are not willing to visit dentists for treatments. Therefore, dentists should build confidence by ensuring cross-infection control. Keywords: COVID-19, patients, fear, anxiety 100
POSSIBLE INVOLVEMENT OF GLUTAMATERGIC, ADRENERGIC AND DOPAMINERGIC SYSTEM IN METHYLPHENIDATE - INDUCED MOTOR ACTIVITY AND MOOD-RELATED ALTERATIONS IN RATS Kowsar Jahanbakshi, Sulail Fatima, Majid Motaghinejad, Manijeh Motevalian J Adv Med Biomed Res 2021, 29(137): 309-316 Background & Objective: Methylphenidate (MPH), as a central nervous system stimulant, is often used to manage hyperactive disorders. The literature is scarce regarding the behavioral consequences of chronic MPH treatment and the role of involved receptors. Thus, in the current study involved receptors in MPH induced-anxiety, depression and motor activity disorders wereevaluated. Materials & Methods: Seventy rats were randomly distributed to seven groups (n = 10, per group); they were treated with normal saline, Domoic acid (DOM) (as AMPA/kainite receptor agonist), Bicuculline (BIC) (as GABAA receptor antagonist), Ketamine (KET) (as NMDA receptor antagonist), Yohimbine (YOH) (as Alpha-2 adrenergic receptor antagonist), or Haloperidole (HAL) (as D2 dopamine receptor antagonist), simultaneously with MPH (10 mg/kg). On days 11, 17 and 24, some standard behavior tests including Elevated Plus Maze (EPM), Forced Swim Test (FST) and Open Field Test (OFT) were used to investigate anxiety, depression and motor activity disturbances, respectively. Results: Our study indicated that pretreatment of rats with KET, HAL and YOH abolished MPH induced - mood and motor activity disturbances. Conclusion: MPH by interacting with Dopaminergic, NMDA and ɑ2-adrenergic receptors induces anxiety, depression and motor activity disorders. Keywords: Methylphenidate, Aanxiety, Depression and Motor activity 101
EFFECTS OF SCHOOL BASED FITNESS TRAINING ON BODY MASS INDEX OF CHILDHOOD OBESITY Umeeda Baz Ali, Dr Amna Khan, Dr Syed Abid Medhi Kazmi, Dr Sumaira Farooqui International Journal Of Scientific & Technology Research Volume 10, Issue 01, January 2021 Introduction: The expressions overweight, obese and severe obesity pass on to an irrefutable field. Intemperance adiposity should be well thought-out an unremitting disease that has severe health consequences, impacting the majority health care professionals including cardiologists, endocrinologists, internists, family practitioners, and pediatricians. Hence, the purpose of this study was to evaluate the effects of school based aerobic training on body mass index (BMI) of obese children that can decrease the risk of cardiovascular diseases due to lifestyle modification and fitness. Methodology: A total of 45 (20 females and 25 males) childhood obese school going children aged between 8 to 14 years participated in this study. PAR-Q and You questionnaire was used for initial screening. The participants found fit for the purpose of training were given conditioning based on aerobic training protocols. At the beginning all participants were asked to perform warm up exercises following by aerobic training including jumping jacks and was performed then participants were given time to cool down. Result: The pre and post analysis suggested that eight weeks protocol based on school based aerobic training significantly reduces the BMI and heart rate of the candidates where the mean values of BMI pre training was found to be 30.82kg/m2 ±2.72 that was decreased to 28.82±2.45 post training of eight weeks with a mean difference of 2±0.5. The p-value at 95% confidence interval was less than 0.05 which indicates that the results are significant. Conclusion: Aerobic training based on school fitness programs if carefully administered and persistently followed can decrease BMI in young obese children that are easy to follow. Keywords: Aerobic training, Cardiovascular diseases, Diabetes mellitus, Heart rate, Intervaltraining, Obesity, School fitness. 102
WORK RELATED STRESS AMONG HEALTH CARE PROFESSIONALS IN KARACHI Shazia Tabussum, Ghazala Noor Nizami, Syed Mukhtar Ahmed, Muhammad Asif, Hina Rathi, Hina Muhammad Munaf Journal of Physical Fitness, Medicine and Treatment in Sports. 8 (5), pp.53-56. 2021 Objective: To explore the work-related stress among health care professionals in Karachi. Design: A Cross-sectional study. Method: A validated questionnaire was used in this study to find out the work-related stress among health care professionals. Sample size of this study was 100. Data was analyzed by SPSS version 21. Result: Out of 100 health care professionals 55% were male and 45% were female. Mean age was 40.66 ± 12.25 while mean of working experience was 14.58 ± 11.77. Role and relationship scale scores highest Mean 4.0360 ± 0.64847 & 4.0175 ± 0.56548, respectively. Change scale and manager’s support scores least mean; 3.7933 ± 0.54181 & 3.8517 ± 0.56353, respectively. Conclusion: Study concluded that change and manager’s support score a least mean and needs improvement while role and relationship score highest mean among all factors of work-relatedstress. Keywords: Work-related stress, health care professionals, Etiology 103
IVERMECTIN USE ASSOCIATED WITH REDUCED DURATION OF COVID-19 FEBRILE ILLNESS IN A COMMUNITY SETTING Muhammad Ishaq Ghauri, Nasir Ali Afsar, Muslim Abbas, Muhammad Shariq Mukarram, Muhammad Yahya Peracha, Khizra Ishaq International Journal of Clinical Studies & Medical Case Reports Volume 13- Issue 4 October 07, 2021 DOI: 10.46998/IJCMCR.2021.13.000320 Background: SARS-CoV-2 infection (COVID-19) is a potentially lethal disease that may progress into severe respiratory dis- tress syndrome requiring ventilatory support. While azithromycin (AZI) and hydroxychloroquine (HCQ) are considered similar to placebo in COVID-19, other drugs such as ivermectin (IVER), are being repurposed to treat this pandemic. This study was designed to assess the effects of ivermectin on duration of febrile illness and disease outcomes in mild-to-moderate COVID-19 infection in a community setting. Methods: In this case-control study 95 suspected patients of mild-to-moderate COVID-19 were included. The controls (Group-A) received AZI+HCQ for seven days while the cases (Group-B) received IVER+AZI+HCQ for six days. Results: A total of 41 patients were in Group-B, while 54 patients were in Group-A. Group-B had consistently and significantly shorter span of fever on days 5, 7, 10 and 14, where the logistic regression showed IVER as the major (Exp B 49·55; p<0·001) underlying factor. The Kaplan-Meier survival analysis showed that Group-A had a prolonged febrile illness (p<0·001). Conclusions: Ivermectin use is associated with reduced duration of febrile illness in COVID-19 in outpatient setting, thus potentially saving precious lives, reducing direct load on healthcare facilities and preventing high cost of management in a community setting. Keywords: COVID-19; SARS-CoV-2; Ivermectin; Azithromycin; Hydroxychloroquine 104
SESQUITERPENE FROM POLYGONUM BARBATUM DISRUPT MITOCHONDRIAL MEMBRANE POTENTIAL TO INDUCE APOPTOSIS AND INHIBITS METASTASIS BY DOWNREGULATING MATRIX METALLOPROTEINASE AND OSTEOPONTIN IN NCIH460 CELLS Zehra, Binte, Ayaz Ahmed, Ajmal Khan, Afshan Shams, Reaz Uddin, Sidra Rafi, Taseer Ahmed Khan, Umar Farooq, Syed Abid Ali DOI:10.21203/rs.3.rs-1187353/v1, 2021 Background: Globally, lung cancer accounts for 18% of cancer-associated mortalities. Among the subtypes, non-small-cell lung cancer (NSCLC) is the most prevalent one. The increased resistance and poor survival rates, signifies disease aggressiveness and thus require a search for an alternative anticancer molecule. Hypothesis/Purpose: Earlier, the isolated sesquiterpene i.e., compound 1 ((E)-Methyl 6-acetoxy-7- methoxy-1-(2-methylpropylidene)-1H-indene-3-carboxylate) from P. barbatum was isolated, characterized by us and reported for preliminary anticancer activity. Considering its potent activity, this study was designed to explore the underlying molecular mechanism of apoptosis and metastasis against NCI-H460 cells. Method: The molecular mechanism of compound 1 inducing apoptosis and inhibiting metastasis was elucidated by analyzing mitochondrial membrane potential, DNA fragmentation, clonogenic assay, invasion assay and expression of apoptotic (Caspases 3, 6, 8, 9 and BAK) and metastatic markers (MMP 2, 9 and osteopontin). Results: Compound 1 significantly inhibited cell proliferation and induced apoptosis via intrinsic route i.e., the mitochondrial pathway by disrupting mitochondrial membrane potential. The enhanced expression of caspases 6, 9, BAK and HRK with downregulation of Bcl-2L1 and Ki67 further confirmed the involvement of the intrinsic apoptotic pathway. Moreover, compound 1 restricted the invasive nature of NCI-H460 cells evinced by reduced cell invasion in Boyden chamber invasion assay and downregulating the expression of metastatic markers i.e., matrix metalloproteinase 2 / 9 and VEGF. It was also found that it blocks osteopontin by negatively regulating its expression; a marker protein in cancer management. Conclusion: Conclusively, this sesquiterpene exhibited potent anticancer and anti-metastaticactivity and can be explored further as possible pharmacophores Keywords: Sesquiterpene, metastasis, angiogenesis, osteopontin, caspases, MMP-2/9 105
POST COVID-19 TUBERCULOSIS: AN EMERGING THREAT OF PANDEMIC Aqusa Zahid , Nousheen Iqbal , Sarosh Moeen, Muhammad Irfan Monaldi Arch Chest Dis. 2021 Mar 31;91(3).doi: 10.4081/monaldi.2021.1749. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) disease (COVID-19) pandemic has hit the world hard. Millions of people have died due to the infection and several have suffered with what are now known as post COVID-19 squeal. Among these squeals one is immunosuppression which leaves patients prone to severe opportunistic infection. We here report a case of young female who was infected by COVID-19 and later developed cavitary pneumonia which upon investigation turned out to be due to mycobacterium tuberculosis. Through this report we aim to highlight the importance of high index of suspicion for infection like Mycobacterium tuberculosis after COVID-19 infection which developed in a healthy immunocompetent patient. Keywords: Tuberculosis, Post COVID-19, Lung infection 106
QUALITY OF SLEEP AND ITS ASSOCIATED RISK FACTORS AMONG MAINTENANCE HEMODIALYSIS PATIENTS IN PAKISTAN Mahjabeen Yaseen, Shagufta Naqvi, Amna Saleem, Rida Nasreen, Rida Imran, Aysha Mahmood Pakistan Journal of Rawalpindi Medical College, 25(2), pp. 165- 170. 30 Jun. 2021 Objective: This study aimed to determine the poor sleep quality and associated risk factors in chronic hemodialysis patients in Karachi. Materials and Methods: This research took place at hemodialysis units of Al Mustafa Medical Institute and Alamgir International Welfare Trust Center after receiving approval from the research committee of respective hospitals. A descriptive cross-sectional study was carried out on a total of 156 patients above 18 years of age from both genders. Quality of sleep was measured using the Pittsburgh Sleep Quality Index (PSQI) and the Hospital Anxiety and Depression Scale (HADS) in dialysis patients. Results: The average PSQI total score in the study population was 6.56 (SD = 4.061), and 89 (57.1%) patients had poor sleep quality (PSQI total score higher than 5). According to the results, smokers had a higher percentage of poor sleep quality 22(81.5%) in comparison to non-smokers. Our results also show a correlation between Hepatitis B (positive) statuses and sleep quality; both Hepatitis B positivity and smoking statuses strongly influencing sleep quality. Conclusion: Poor sleep quality seemed to be a very common problem among dialysis patients and should be addressed by the hospital management to a greater extent. Further research is required to study each associated factor in detail. Keywords: Dialysis, Sleep-quality, HADS, PSQI. 107
RADIOLOGICAL FINDINGS OF COVID-19 PATIENTS WITH PNEUMONIA, KARACHI PAKISTAN Samia Perwaiz Khan, Safia Izhar, Shazia Kadri Open Journal Of Radiology, 2021,(11): pp35-44. Objectives: To study the clinical and radiological features in assessing the severity of COVID 19 pneumonia with the help of Chest X-ray (CXR), High resolution computed tomography (HRCT), and ultrasound. Methods: This prospective study was performed at Medicare Cardiac and General Hospital and Jinnah Medical College Hospital Korangi (JMCH) from April to June 2020 included 50 COVID 19 patients with positive PCR . Patients symptoms included high grade fever, cough, dyspnea etc. Their clinical features were recorded. Real time polymerase chain reaction (RT-PCR) was done for the confirmation. Radiological imaging including Chest X-ray, HRCT chest and ultrasound was performed to study the severity of symptoms. Results: Fifty patients of COVID 19, with complaints of high grade fever, sore throat, dry cough, body ache, headache, shortness of breath, fatigue, unexplained weakness and reduced oxygen saturation were included. Twenty two patients had mild symptoms with oxygen saturation between 80-88%, twenty patients had mild to moderate symptoms with oxygen saturation between 70-80% and eight patients infected cases with oxygen saturation reduced to 65-70%. Three of these were severely ill patients with ultrasound findings of pleural effusion and ascites. Patients with mild symptoms were followed up showing almost normal Chest X rays but single or patches of ground glass opacity were seen. HRCT of five patients with low oxygen saturation were already performed from different centers showing bilateral peripheral patchy consolidation predominantly involving mid and lower lobes. Conclusion: Diagnostic imaging, especially CT-Scan has high significance to diagnose COVID 19 and severity of infection, Chest X- ray and ultrasound were also found to be very useful tool. Keywords: High Resolution Computed Tomography Scan (HRCT-Scan), CXR- Chest X-ray, Ultrasound, Ground Glass Opacities (GGOs), Corona virus disease 2019- COVID19. 108
RAPIDLY PROGRESSIVE DIABETIC KIDNEY DISEASE: SOUTH ASIAN EXPERIENCE Sonia Yaqub, Amna Hamid, Waqar Kashif, Muhammad Raheel Abdul Razzaque, Aisha Farooque, Bilal Ahmed, Nanik Ram International Journal of Diabetes in Developing Countries https://doi.org/10.1007/s13410-021-00975-z Objective: There is limited discussion in the literature on clinical and pathological features of the rapidly progressive variant of diabetic nephropathy (DN). We aim to highlight the clinic-pathologic characteristics of biopsy proven DN in patients with type 2 diabetes (T2DM) and a rapid decline in glomerular filtration rate (GFR). Methods: We conducted a cross sectional study of patients with rapidly declining GFR and biopsy proven isolated DN from 2012 to 2018. Data on clinical details, laboratory, and histologic findings was collected. Results: A total of 46 patients were included; mean age was 49 ± 12.7 years with a predominantly male preponderance. Majority of the patients (82%) had hypertension and more than 40% required more than one antihypertensive medications. About half of the patients (47%) were on reninangiotensin-system (RAS) inhibitors, and 70% were either overweight or obese. Almost half of the patients had HbA1c values greater than 7% and about 71% were on insulin. Mean urinary protein was 4.5 ± 2.6 g. Nodular and global glomerulosclerosis were the most common histologic findings, while 26.1% patients had crescents. During follow-up, 30% had one or more hospitalizations with congestive heart failure and 30% progressed to end-stage kidney disease (ESKD). Mean time to ESKD was 9.69 ± 17.87 months. Conclusion: Younger age, higher body mass index, coexisting hypertension, overt proteinuria, and suboptimal glycemic and blood pressure control with underutilization of RAS inhibitors were prevalent in rapid decliners in DKD. Rapidly progressive diabetic kidney disease is a globally underrecognized entity, and this is the first experience shared from the South Asian region. Keywords: Diabetes, Diabetic kidney disease, Diabetic nephropathy, End-stage kidney disease 109
CORNELIA DE LANGE SYNDROME: A RARE CASE Syeda Seemin Raza, Maryam Haider, Maria Khan, Yousuf Farooqi, Uzma Arshad, Meher Afroze, Bushra Rafique, Nadeem Noor Annals of Pediatrics; August 2021; 4(1): 1074. ISSN: 2637 9627 Online edition: http://meddocsonline.org Cornelia de Lange Syndrome (CdLS) is a genetic disorder. It has an autosomal dominant pattern of inheritance and is characterized by multisystem malformations. In this report, we present a case of a newborn having distinctive features such as: Facial dysmorphia (arched eyebrows, synophrys, depressed nasal bridge, long philtrum, down-turned angles of the mouth), upper-extremity deficiency or shortening, hirsutism, cardiac defects, cognitive retardation and gastrointestinal abnormalities. The purpose of this report is to highlight the importance of screening in children with congenital cognitive and growth defects, and to raise a high index of suspicion for this particular syndrome, whenever such features are observed in a newborn. Keywords: Cornelia de Lange syndrome; Genetic disorder; Autosomal dominant; Malformation; Facial dysmorphia; Synophrys; Depressed nasal bridge; Hirsutism; Cardiac defects; Retardation 110
ROLE OF C-REACTIVE PROTEIN AND GAMMA-GLUTAMYL TRANSFERASE IN THE DIAGNOSIS OF METABOLIC SYNDROME Rubina Ghani, Mozaffer Rahim Hingorjo, Samia Perwaiz Khan, Uzma Naseeb, Shaista Emad, Afrasayab Khan Khattak, Alina Fatima Iqbal, Mauyur Sarhadi and Navneet Sarhadi International Research Journal of Medicine and Medical Sciences Vol. 9(4), pp. 118-124, December 2021 DOI: 10.30918/IRJMMS.94.021.039 ISSN: 2354-211X Previous studies have reported that metabolic syndrome (MetS) is associated with an increased risk of major cardiovascular events and levels of C-Reactive protein (CRP) can be considered as markers of MetS and its constituent components. Oxidative stress plays a major role in the development of MetS, and levels of gamma-glutamyl transferase (GGT) change with response to oxidative stress are also associated with MetS, which may be modulated by CRP. This study was conducted to identify the role of GGT and CRP as biomarkers in the diagnosis of MetS, a high-risk factor for cardiovascular diseases. One hundred and fifty patients meeting the diagnostic criteria of MetS and an equal number of controls were included in the study. The cases were selected from pathology and molecular biology laboratories, Karachi, while the controls came from the general population. Anthropometric indices of adiposity and blood pressure were recorded for both cases and controls. Blood samples were taken from all subjects to determine the levels of CRP and GGT. All those cases and control height, weight, hip waist circumference were noted and the comparison of CRP and GGT by applying students' t-test as markers for detection of metabolic syndrome. p-value 0.001 was considered as significant. This study suggests that in patients with metabolic syndrome were found to have raised the basal metabolic rate, C-reactive protein and GGT were synergistically associated with MetS independently of another confounding factor in the general population. Keywords: C-reactive protein (CRP), gama glutamyl transferase (GGT), metabolic syndrome, (MetS), inflammation, body mass index. 111
PREVALENCE OF BACTERIA AND ANTIMICROBIAL RESISTANCE GENES IN HOSPITAL WATER AND SURFACES Maira Aleem, Abdul R. Azeem, Sidra Rahmatullah, Sufyan Vohra, Shumyila Nasir, Saadia Andleeb Cureus, Vol 13, Issue 10, e18738, 2021 Purpose: Antimicrobial resistance (AMR) has become a worldwide environmental and public health problem, causing more than 250,000 deaths per year. Unregulated usage, unsafe hospital practices, and misuse in veterinary contribute to the development of multidrug resistance in various bacteria. Hospital water was hypothesized to be a hotspot for AMR transmission because of increased exposure to antibiotic load, poor drainage and sanitation system, interaction between environmental and clinical microbes. The purpose of the research was to assess the biodiversity and AMR in hospital tap waters. Results: Among these 162 isolates, 82 were obtained from water sources and 80 were collected from surfaces (faucet, basin, drain). The isolates included a variety of bacteria including Aeromonas spp. (20%), Klebsiella spp. (13%), Staphylococcus aureus (13%), Pseudomonas spp.(10%), Escherichia coli (9%), Vibrio spp. (8%), Enterococcus spp. (6%), Shigella spp. (6%), Salmonella spp. (4%), Acinetobacter spp. (3%), Staphylococcus epidermitis (3%), Streptococci spp. (2%), Proteus spp. (1%), Citrobacter spp. (1%), and Serratia spp. (1%). A diverse range of microbes were identified including clinically relevant bacteria, which shows that the urban water cycle is already contaminated with multidrug-resistant microflora of the hospital settings. Macrolide and lincosamide showed the highest resistance followed by penicillin, monobactam, and cephalosporins. blaSHV and blaTEM were prevalent in samples. blaNDM was also found which manifests as a real threat since it causes resistance against carbapenems and colistin, antibiotics reserved as a last resort against infections. Conclusions: This study presented the ground reality of antibiotic resistance in Pakistan and how its subsequent spread poses a great threat to the strides made in the field of medicine and public health. Strict regulations regarding antibiotic usage, hospital effluent, and urban water sanitation must be imposed to curb the devastating effects of this increasing phenomenon. Keywords: colistin resistance, multi-drug resistant bacteria, beta-lactamases, hospital surfaces, hospital tap water, antibiotic resistance genes, transmission, antimicrobial resistance 112
MEASURING ANEXUS BETWEEN FINANCIALSECTOR DEVELOPMENT AND ECONOMIC GROWTH IN CASE OFPAKISTAN: AN EMPIRICAL APPROACH USING ARDL METHOD Prof. Dr. Masood Mashkoor Siddiqi, Dr. NaziaAbdul Rehman, Dr. Khurram Shakir, Dr. Musarrat Shamshir Indian Journal of Economics and Business Vol. 20 No. 4 (December, 2021) The primary objective of this research based on empirical investigation, is to identify the nexus between financial sector development and economic growth in case of Pakistan. Present Pakistan’s government took many initiatives to develop more efficient financial sector in order to facilitate more suitable business and economic environment in the country. Due to these initiatives, Pakistan’s GDP growth rate increases successfully even in the period of corona virus pendemic that affects many developing and developed countries negatively. for this purpose, times series data is utilized, time span from 1971 to 2020 by applying econometric techniques to measure the relationship among variables of interest. The result of the study establishes both long-run and short-run dynamics of variables. In the last section of the paper, conclusion with policy recommendations is also included. Keywords: Financial development, economic growth, ARDL, Pakistan 113
PATTERNS OF DRUG PRESCRIBING AND PRESCRIBING ERRORS AT IN-PATIENT PEDIATRIC DEPARTMENTS OF GOVERNMENT HOSPITALS, KARACHI, PAKISTAN Najia Rahim, Shagufta Nesar, Muhammad Harris Shoaib, Syed Baqir Shyum Naqvi, Tahmina Maqbool, Shazia Qasim Jamshed Southeast Asian J Trop Med Public Health. Vol 52 No.2, pp. 342-353. March 2021 Trend of drug prescribing and prescribing errors including adverse drug-drug interaction in prescriptions at in-patient pediatric departments of two government hospitals in Karachi, Pakistan was evaluated in a prospective observational study from 1 December 2017 to 28 February 2018 using the World Health Organization core indicators. Drug prescriptions contained 4 ± 2 (mean ± SD) drugs per prescription, with ceftriaxone and paracetamol being the most common. Prescriptions of more than five drugs were 5 times more prone to have drug-drug interactions compared to those of fewerdrugs. Children were prescribed a higher number of drugs than the WHO recommended 1.6-1.8 drugs per prescription. Brand name drugs were the choice of the majority of pediatricians. There was a noticeable absence of the latest national essential list of medicines at pediatric wards. Further nationwide studies should be conducted to ascertain the complete status of pediatric prescriptions in Pakistan so that improvements to the system can be recommended. Keywords: drug-drug interaction, in-patient, Karachi, pediatric department, prospective study. 114
COVID-19 IMMUNIZATION PHASE; ACCEPTANCE & UNDERSTANDINGS ABOUT THE VACCINE Shagufta Nesar, Kiran Rafiq, Shaheen Perveen, Tayyaba Mumtaz International Journal Of Endorsing Health Science Research Volume 9 Issue 4, pp. 426-430. October 2021 Background: In the current scenario of global immunization against Coronavirus, people do have an uncertain thought regarding the efficacy and effects of the vaccine. The purpose of this study was to assess the knowledge, awareness, and acceptability of vaccines among the general population of Karachi. Methodology: For the purpose of the study, literature focusing on the knowledge, awareness, and acceptance regarding COVID-19 immunization was reviewed. Google Scholar, PubMed, Research Gate, and Scopus were searched using the keywords COVID-19, non-pharmaceutical Interventions, immunizationrelated knowledge, awareness, and acceptance. A pilot study was designed to demonstrate the COVID-19 immunization understanding and acceptability. Results: Low rate of acceptability for getting vaccinated is observed in the local population. Most perceptions indicated vaccines to be not healthy, harmful, and life-threatening. Conclusion: The current situation of fast-spreading of the virus and the non-acceptance of vaccines is highly alarming for community and health authorities and demands strong health care measures and campaigns to control the disaster. Keywords: Corona Vaccine, Pandemic, Non-pharmaceutical Interventions, Karachi. 115
PHARMACISTS’ INSIGHTS AND BEHAVIORS IN PREVENTING THE MISUSE OF TOPICAL CORTICOSTEROIDS IN PAKISTAN: A MIXED-METHOD STUDY Sadia Shakeel, Shagufta Nesar, Wajiha Iffat, Hina Rehman, Samreen Aziz, Tayyaba Mumtaz, Hazrina Hadi, Shazia Jamshed Cosmetics 2021, 8, 72. https://doi.org/10.3390/cosmetics8030072 Topical corticosteroids (TCs) misuse has become a common issue for healthcare professionals and patients, particularly in Pakistan, as no stringent laws or rules are prohibiting the selling of over-thecounter medicines. The present study was designed to examine pharmacists’ insights and behaviors regarding TCs and their potential role in preventing the misuse of TCs in Pakistan. The study was a cross-sectional mixed-methods research design (phase 1, quantitative; and phase 2, qualitative) conducted from January to June 2021. The pharmacists working in various settings in Karachi were approached through different social media platforms. Data were collected through a web link of an online questionnaire with 30 closed-ended questions. Different statistical methods were employed for tabulating the quantitative data, while inductive thematic analysis was directed to classify themes from the qualitative data and to conclude findings. The mean cumulative knowledge score was 10.59 ± 1.63. The community pharmacists knew more about the available over-the-counter TCs (p = 0.041). The experienced pharmacists were more conversant than fresh pharmacists, regarding the mode of action (p = 0.008), choice of TC potency (p = 0.001), and most common local and systemic adverse effects of TCs (p = 0.001). Overall, respondents had a favorable attitude, with more than 80% agreeing that pharmacists could ensure that important safety issues are communicated with patients, and assist considerably in avoiding TC misuse. Analysis of data has produced 7 themes, 10 sub-themes, and 30 categories. Major themes included: use and misuse of TCs, adverse drug events due to TCs, cosmetovigilance, patient education, referral to a physician, and future perspectives for preventing TC misuse. The respondents were well versed with the dilemma of TCs misuse, and they considered patient characteristics, free availability of TCs, and lack of physician-pharmacist coordination as the major reasons. The major barriers for patient education stated by nearly all the respondents were a lack of time and lack of material/information for counseling. They emphasized the need for stringent legal strategies and the enforcement of current drug-control regulations, so that TCs are not supplied without appropriate prescriptions. The present findings indicate that pharmacists had appropriate knowledge and a positive attitude towards their potential role in preventing the misuse of TCs. Further education and sensitization in areas of deprived knowledge will undoubtedly aid in the prevention of TCs misuse by the community. Keywords: Pharmacists; mixed-method study; misuse; topical corticosteroids; cosmeto-vigilance; Pakistan. 116
APPROACHES AND PERSPECTIVES FOR ONLINE LEARNING DURING THE COVID-19 PANDEMIC AND FUTURE CHAOS Shagufta Nesar, Kiran Rafiq, Muhammad Rizwan, Syed Mehmood Hasan Journal of Education and Health Promotion Volume 10, DOI: 10.4103/jehp.jehp_951_20. 2021 Background: Online learning (OLL) methodology has been incorporated in higher education extensively on the mount over the last few decades and with the onset of COVID-19 situation, the virtual method in academia became essential. After observing worldly destructions and death due to coronavirus, the WHO declared a high alert emergency, and since Pakistan started to follow lockdown since March 2020 to prevent high penetration and consequently, the online teaching method was adapted to keep the learning atmosphere alive. The study is aimed to identify the influencing factors and compliance for the implementation of the OLL system in COVID-19 and, in the future, non pandemic state as well. Materials And Methods: The present study is designed to observe the adaptability and hurdles among pharmacy students, and for the purpose of the study, a questionnaire on the Likert scale was developed and asked to respond from pharmacy undergraduate and postgraduate students after taking consensus, which further analyzed through IBM SPSS Statistics Version 26. Results: The outcomes of the study were analyzed with a high level of conformity; however, the gender-based reservations were observed, and moreover, merits of OLL were observed with high jeopardy. Conclusion: The adaptation of OLL, though proved as the only trouble shooter in an uncontrollable situation and enabled universities, professors, and students for patience, resilience, and hopefully, will serve as swift safeguard for future challenges of epidemic and pandemic disasters. According to the evolution theory, brain adaptability and plasticity of human organisms grow the capacity to adjust itself with an advanced characteristic. Keywords: Coronavirus, COVID-19, epidemic, Likert scale, online learning, pandemic, pharmacy. 117